The emergency health services in Pakistan are in shatters due to inadequate medical facilities, crumbling infrastructure, and unskilled trained personnel. But the ambulance service which is a very crucial element for health operations is in dire condition.  While this has affected the overall medical services across Pakistan, the remote and difficult terrain areas are worst-hit. Shockingly, people in Pakistan prefer normal modes of transport over ambulances, as those using the latter claimed to have had a higher incidence of death or hospital admission. 
    
Patients who were transported to the emergency department ambulance were 7.2 times more likely to die than non-ambulance patients, revealed a study carried out by a group of medical researchers from Johns Hopkins Bloomberg School of Public Health in the US and Aga Khan University in Pakistan. “The utilization of ambulances is very low in Pakistan. Only 4.1 percent of the patients coming to the major EDs in Pakistan use ambulance services. There are no global standards for appropriate utilization rate for ambulances,” they said in the study.

Moreover, ambulance services in Pakistan are regularly blamed for charging exorbitant charges from helpless patients. Usually, PKR 1,000-1,200 are supposed to be charged by ambulances within a city. However, they were found to be forcing patients and relatives to shell out PKR 4,000-7,000. "The government ambulance is in disrepair while the private ambulance services are demanding Rs4,000, which is beyond our means. We are poor people,’ said Sakina Bibi, whose daughter delivered a baby girl.   

A writer named Khurram Zia Khan said the richest city in Pakistan, Karachi, did not have adequate lifesaving ambulances while regular ambulances lacked the requisite facilities and equipment needed to administer pre-hospital treatment to patients. “If people living in the city’s more upscale localities struggle to get even basic services, what must be the problems faced by residents in underprivileged localities?” he said. 

A study carried out by health researchers in Pakistan showed that people had developed a negative opinion of emergency medical services. “The poor utilization of ambulances in Pakistan has often been blamed on the lack of prehospital treatment, incompetent employees, and poorly equipped transportation facilities, all of which contribute to a lack of confidence in the EMS system,” read the study led by Dr Omer A Shaikh of Karachi-based Ziauddin University. 

Air ambulance service is very important for poor countries like Pakistan, where road infrastructure is not developed to reach patients in remote areas and the northern parts where snowfall blocks roads. However, it is still in a nascent stage. And major provinces like Punjab and Sindh could have begun it on a pilot basis. However, other provinces such as Khyber Pakhtunkhwa, Northern Areas, which need air ambulances than any other provinces, do not have access to this modern facility. 

According to the World Health Organisation (WHO), there should be one ambulance for every 50,000 people. So ideally, Pakistan must have around 4,800 ambulances to cover its 240 million population. However, there is a huge gap between the actual requirement and the ambulances available. Notably, the majority of ambulances operating in Pakistan are either owned by private hospitals or donated by non-governmental organisations (NGOs).  

The richest city of Karachi has been struggling to get an adequate number of ambulances as the actual number of ambulances in operations is less than half of what is needed. A few years ago, the Sindh government had roped in an NGO to launch a free ambulance service. However, it was to be suspended soon after it was started due to a lack of funds for maintenance.       

Punjab Government Health Secretary Ali Jan Khan, who worked on a model to reduce the mortality rate among pregnant women, highlighted mismanagement in the ambulance services operated by the Islamabad government. “The ambulance service provided by the Government of Pakistan, through its routine service delivery model, was hampered by misuse of vehicles, lack of timely maintenance and lethargy in public sector service delivery,” he said.